Living with Obsessive-Compulsive Disorder

People with obsessive-compulsive disorder (OCD) experience obsessions, compulsions, or both. “Obsessions are unwanted thoughts, images, or impulses that an individual experiences over and over again,” said Andrea Umbach, PsyD, a clinical psychologist who specializes in treating anxiety disorders at Southeast Psych in Charlotte, N.C.

They’re often disturbing and cause tremendous anxiety.

As Mara Wilson writes in this piece on things no one tells you about OCD, “Imagine the feeling of having a song stuck in your head. Now imagine that instead of ‘It’s Raining Men,’ it’s the thought of murdering your best friend. In graphic detail. Over and over again. You’re not mad at your best friend, and you’ve never done anything violent, but it won’t stop playing.”

Even when thoughts aren’t this disturbing, they’re always unpleasant, play on repeat, and spike anxiety. In order to reduce or prevent the negative emotions and distress, people with OCD often engage in compulsions, which Umbach defined as “repetitive actions, either physical or mental.”

People might develop rituals such as “checking, arranging, or repeating things until it feels right.” They might count or say phrases in their heads to defuse an obsession, she said. “Individuals with OCD might also ask many questions in order to receive reassurance that everything is going to be OK.”

They might ask others about whether they’ve done anything wrong, such as “Did I run someone over with the car?” “Am I a pedophile?” or “Am I going to go to hell?” said Tom Corboy, MFT, founder and executive director of the OCD Center of Los Angeles.

People with OCD carry intense shame about their disorder, which makes it an isolating illness. But if you have OCD, you’re not alone. According to the National Institute of Mental Health, OCD affects about 2.2 million American adults. Worldwide OCD and its related disorders affect more than one in 100 people, according to the International OCD Foundation.

Below, you’ll learn more about what obsessions and compulsions look like, persistent myths about OCD, the gold standard for treating OCD, and more.

A Closer Look at Obsessions & Compulsions

Contamination is the most common type of OCD, said Chapman. Individuals obsess over contracting a disease from objects, places, or people, he said. They engage in compulsions such as excessive handwashing, showering (after they feel “contaminated”), and cleaning their items, he said.

People with OCD also commonly struggle with aggressive obsessions (such as Wilson described above), which may manifest as thoughts, images, or impulses of unintentionally hurting others, Chapman said. “For example, [someone might have a] fear of stabbing a loved one with a sharp object from the kitchen, fear of driving due to striking pedestrians, or unintentionally poisoning a loved one.”

Individuals don’t have any intention of committing these acts. And, understandably, these thoughts are highly distressing to them, he said. To soothe the distress, they may engage in different rituals, such as “retracing driving routes for hours out of fear of ‘yellow tape’ and accidentally causing [a car] accident, avoiding sharp objects or weapons at all costs, and avoiding aggressive movies.”

Another form of OCD is scrupulosity. This includes obsessions about religion, morals and “scruples” or “doing the right thing,” Chapman said. People might worry about everything from committing a horrible sin to offending others.

“Rituals may take the form of reassurance seeking from pastors or clergy as attempts to confirm that one did not commit the unpardonable sin, excessive trips to confession, repeating prayers, signs of the cross when hearing of traumatic events, and avoiding religious activities including reading of scripture.”

Individuals may also compulsively avoid feared objects or situations, Corboy said. They may avoid spending time with their kids for fear of harming them, or avoid sharp objects for fear of stabbing someone, he said.

Myths About OCD

Myth: Repressed issues underlie OCD. “Many people spend years in psychoanalysis searching for nonexistent issues in an effort to explain why they are experiencing unwanted thoughts,” Corboy said. However, people with OCD have these types of thoughts because everyone has these thoughts. The difference is that people with OCD “get stuck on them, and do specific behaviors in an effort to escape the anxiety caused by them,” he said. While we don’t know what causes OCD, it seems to have a genetic basis, Corboy said. “OCD is sometimes ‘triggered’ by stressful events in that it appears to develop as a learned, maladaptive, coping response employed in an effort to manage that anxiety.”

Myth: Everyone is a little OCD. According to Umbach, “The words ‘OCD’ and ‘obsessed’ tend to get thrown around carelessly.” Again, OCD is a debilitating disorder (and goes beyond being casually preoccupied with something). When it isn’t taken seriously, people can suffer needlessly because they don’t seek help, she said.

Myth: If people could relax, they wouldn’t have OCD. “Actually, people with OCD are usually doing everything they can to reduce discomfort,” Umbach said. That’s the purpose of compulsions — to stave off anxiety and relax, she said. However, seeking comfort only perpetuates OCD. “What individuals with OCD actually need is a structured, supportive program to help them break free from OCD’s repetitive cycles.” (The gold standard of OCD treatment is discussed below.)

Myth: People who have a tendency toward perfectionism or orderliness “are OCD.” “On numerous occasions, I have heard people state, ‘she is so OCD’ when they are describing behaviors that occur in certain contexts rather than the presence of true obsessions and compulsions,” Chapman said. However, he noted that these symptoms may indicate an unrelated — though similarly named — disorder called obsessive-compulsive personality disorder (OCPD).

Treatment of Choice

“One of the first steps to managing OCD is taking symptoms seriously,” Umbach said. If you’re struggling with distressing obsessions or compulsions, she said, don’t dismiss them. “There is no shame in asking for help.”